EmployeeBenefitsJobs.com logo BenefitsLink.com logo

BenefitsLink Health & Welfare Plans Newsletter

April 26, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
         Past Issues  |  Search

Employee Benefits Jobs

Paralegal/Legal Administrator
for Transamerica Retirement Solutions in MA

401(k) Administrator
for Established TPA Firm in CA

Plan Administrator
for Verisight, Inc. in IL

Enrollment Center Manager
for Univers Workplace Solutions in CA

Consulting Actuary
for Verisight, Inc. in IL

Post Your Job on employeebenefitsjobs.com

View All Jobs

RSS feed for jobs RSS Feed: All Jobs

Webcasts and Conferences

We also publish the BenefitsLink Retirement Plans Newsletter (free): Subscribe


[Guidance Overview]

Progress, But Much Work Remains on Implementing Health Reform Rules: SBC FAQs for 2014
"The agencies had stated earlier that they would also change the form for 2014 to reflect the statutory elimination of all annual dollar limits on essential health benefits. The agencies are not making this change, but insurers or plans must state that no annual dollar limits are in fact imposed on essential health benefits. In a major disappointment to consumers, the agencies are not adding any new coverage examples for 2014." (Health Affairs)

[Guidance Overview]

More Guidance Issued on Summaries of Benefits and Coverage
"The new template includes two new entries that address whether the plan provides minimum essential coverage and meets the minimum value standard.... The FAQs provide specific instruction regarding the entry on overall annual limits.... Otherwise, the guidance makes few changes. Most significantly, no new example is required to be included, and the FAQs extend various policies regarding relief from enforcement related to the SBCs." (Ballard Spahr)

City of Philadelphia's Health Plan to Cover 'Gender Confirmation' Surgery
"[Philadelphia's] City Council approved a bill ... that would require the city's health plan to pay for transgender city workers to complete 'gender-confirmation surgery'.... The bill would establish transgender health benefits for city workers to cover psychotherapy, hormone treatments, laser-hair removal and gender-confirmation surgery, which costs about $50,000 per procedure.... The bill would also provide up to two tax credits ... to companies that start offering health care for life partners and their children and covering transgender medical needs." (Philadelphia Inquirer)

San Francisco Commuter Benefits Online Reporting Requirement Due by 4/30/13
"You will need your 6-digit San Francisco Business Registration Certificate Number in order to complete the form. If you do not know this number, you can search for the number online or the website has a phone number you may contact in order to obtain the number." (TRI-AD)

How is a Health Plan Reimbursement Provision Like Living in a Submarine?
"It is worth pausing to reflect on the [United States Supreme Court's] attitude towards 'default' rules of equity, such as the double-recovery and common-fund rules. They apply unless they are specifically excluded. In other words, the Court views them as an automatic feature of any reimbursement agreement, unless they are expressly rejected. A properly drafted reimbursement provision must therefore do more than create the proper lien: it must anticipate all potentially applicable principles of equity and control them. This is a bit like proving a negative or trying to keep dry in a submarine." (SpencerFane)


BenefitsLink would like your help

Sponsored by BenefitsLink

We're excited to be working on ways to enhance your experience with BenefitsLink.com and we'd really appreciate your feedback and opinions. Please take our quick survey. Thanks!

Sen. Hatch Questions Obamacare Transition Period for Massachusetts
"Sen. Orrin Hatch (R-Utah) is criticizing [HHS] for allowing Massachusetts to take three years to comply with certain requirements under ObamaCare without granting similar flexibility to other states.... 'State regulators throughout the country have expressed to you their concerns about the impact of rating reforms on the operations of their markets,' Hatch wrote to [HHS] Secretary Kathleen Sebelius. 'It seems only reasonable that the department has the same authority to offer flexibility to all states.'" (The Hill)

Democratic Senators Tell White House of Concerns About Health Care Law Rollout
"Senator Jeanne Shaheen, Democrat of New Hampshire... said, 'We are hearing from a lot of small businesses in New Hampshire that do not know how to comply with the law.' ... Senator Tom Harkin, Democrat of Iowa and chairman of the appropriations subcommittee on health care, said he was extremely upset with Mr. Obama's decision to take money from public health prevention programs and use it to publicize the new law, which creates insurance marketplaces in every state." (The New York Times)

Large Shares of Adults Are Uninsured or Underinsured in the Nation's Largest States
"In Florida and Texas, more than half (53% and 54%) of adults were either uninsured during the year or underinsured ... Nearly half (48%) of Floridians reported they had difficulty paying medical bills or were paying off accrued medical debt ... This was 14 percentage points higher than the share of adults reporting these problems in California, where 34 percent had medical bill problems or debt[.]" (The Commonwealth Fund)

Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the ACA
"[N]early 8 of 10 (79%) young adults reported that they were insured at the time of the survey in 2012, up from 69 percent in 2010, or a gain in health insurance coverage for an estimated 3.4 million young adults. This marks an abrupt reversal in a decade-long upward climb in the number of uninsured young adults ... [N]early half (46%) of U.S. adults ages 19 to 64, an estimated 84 million people, did not have insurance for the full year or had coverage that provided inadequate protection from health care costs[.]" (The Commonwealth Fund)

Not Much 'Sticker Shock' in CareFirst's Proposed 2014 Maryland Health Insurance Rates
"The 25 percent average increase that has received so much attention is an average across all of the plans that CareFirst and its affiliates will offer. Notably, CareFirst is assuming that 80 percent of the parent company's 2014 expected enrollment will be in plans offered by BlueChoice, for which CareFirst is predicting an average 12 percent annualized rate increase compared to 2013. That's not insignificant, but it's in the range of the increases people in the individual market have typically seen before health reform." (Center on Budget and Policy Priorities)

More Than Half of Population Not Wedded to a Particular Doctor
"[W]hile a substantial minority of the population will in fact want to be certain that their physician participates in a health plan before selecting that plan, a surprising majority considers this an open question. Nearly twenty-four percent of the respondents report that they do not have a regular doctor, while an additional thirty-four percent would switch in order to receive premium savings. Over half of the latter group would do so for the lowest savings amount presented by the survey, $500 to $1,000 annually." (HealthPocket)

Reid on Obamacare for Congressional Employees: 'No Legislative Fix Is Necessary'
"Senator Reid is committed to ensuring that all members of Congress and Congressional staff experience the benefits of the [ACA] in exactly the same way as every other American.... There are not now, have never been, nor will there ever be any discussions about exempting members of Congress or Congressional staff from [ACA] provisions that apply to any employees of any other public or private employer offering health care." (The Washington Post)

New Health Exchanges Unlikely to End Insurance Monopolies in Some States
"A recent analysis by the American Medical Association found that a single insurance company held 50 percent or more of the market in nearly 70 percent of local markets nationwide. And in 30 states, a single insurance company covers more than half the people who purchase insurance individually[.]" (Kaiser Health News)

Survey Results: American Workers on Uphill Road with Consumer-Driven Health Care (PDF)
"Nearly three-quarters (72 percent) of the workforce have not heard of the phrase 'consumer-driven health care'; More than half (54 percent) of workers would prefer not to have greater control over their insurance options because they don't have the time or knowledge to effectively manage it; 62 percent of workers believe the medical costs they will be responsible for will increase, while only 23 percent are saving money for potential increases; 75 percent of workers said they think their employer would educate them about changes to their health care coverage as a result of reform, but only 13 percent of employers said educating employees about health care reform was important to their organization." (Aflac)

DOL to Increase Frequency of FMLA On-Site Investigations
"The DOL reports that on-site visits are easier for its investigators largely because: 1) it tends to make the investigation less time consuming for the agency; 2) investigators have ready access to records, data, FMLA policies and FMLA forms; and 3) investigators can interview employees face-to-face while reviewing documents on-site." (FMLA Insights)

Insured But Unable to Afford Health Care
"'Obamacare is lowering the bar for health insurance,' said Dr. Himmelstein, a professor of public health at the City University of New York and primary care doctor. 'The new coverage sold through the insurance exchanges will leave many families paying 40 percent of their health costs out-of-pocket even after they've laid out thousands for premiums. And the administration is allowing states to institute co-payments under Medicaid, even for the poorest of the poor.'" (Physicians for a National Health Program)

To Cut Health Bills, Boomers Need 20-Somethings
"[The ACA] marketplaces will improve boomers' access to health coverage and may even bring down underlying premiums for those who don't qualify for a government subsidy, experts say. But boomers may not see those cost benefits unless they get some help from a different demographic: Their kids and their friends' kids." (MarketWatch.com)

Comprehensive Assessment of ACA Factors That Will Affect Individual Market Premiums in 2014
"Covering pre-existing conditions, requiring a broader benefit package, and covering uninsured Americans who have gone without medical care will benefit millions of people while increasing the cost of health care coverage. The new health insurance tax and other fees will also increase premiums. Other provisions of the law will make health care coverage more affordable, including premium and cost-sharing subsidies and the transitional reinsurance program, which provides funds to help offset the impact of high-cost enrollees." (Milliman for America's Health Insurance Plans)


ACA Is an 'Experiment' That Will Fail
"'People will not be able to afford the health insurance that they're being pushed to buy,' Dr. Andrew Coates, president of Physicians for a National Health Program (PNHP), said ... 'And when they do buy it, it won't be good enough to cover health-care calamity.' ... '[I]t's a big experiment to drive people to [the health insurance] marketplace but the health insurance marketplace hasn't worked for years now and I don't see any evidence that's going to change,' he said." (Physicians for a National Health Program)


Text of Comments to DOL, HHS and IRS on ACA Out-of-Pocket Rules (FAQs Part XII) (PDF)
"The out-of-pocket limits should apply only to essential health benefits, as determined in good faith by large employers. The out-of-pocket limits should apply only to the employer's lowest cost coverage that provides minimum value ... The Departments should affirm that the out-of-pocket limits do not apply to retiree health plans.... The limitation on the amount for deductibles should apply only to health plans in the small group market." (The ERISA Industry Committee)


Text of Comments to CMS on Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (PDF)
"CMS has made a concerted effort , in developing regulations implementing Section 1857(e)(4) of the Social Security Act, to closely mirror the regulations implementing the commercial health insurance MLR provisions enacted under Section 2718 of the Public Health Service Act. Consistency between the Medicare MLR regulation and the commercial MLR regulation is an appropriate approach . Our comments focus on a few areas in which further clarification would be helpful or for which we wanted to provide some additional thoughts based on our experience with the commercial MLR regulation." (Medical Loss Ratio Regulation Work Group, American Academy of Actuaries)


How to Do Your Homework on Health Care Reform
"The reality ... is that 'consumers do not understand their health insurance coverage -- including benefit limits and exclusions, network designs, and cost sharing features.' They don't know how to evaluate insurance choices, either, or how to resolve problems when health claims are denied or where to turn for help. What's more, at least in terms of health care reform, consumers know that they are not well-informed." (U.S.News and World Report)


21st Century Health Care Options for the States
"The reasons why states should NOT participate in Obamacare's Medicaid expansion are well-documented ... Less well known ... are the innovative programs states have utilized over the past several years to modernize and enhance their health sectors, expanding coverage and improving quality of care while lowering costs.... [T]hese policy solutions seek to transform Medicaid using market incentives to create a health system that works for patients." (Galen Institute)


Members of Congress Want to Be Exempt from Obamacare Rules
"[T]here are two major reasons why Members of Congress want to exempt themselves and their staffs from the terms and conditions of the law: They fear higher health care costs.... They fear the impact on Capitol Hill employment.... If Congress quietly wants to exempt itself from Obamacare, that's great -- so long as it includes the rest of us in that midnight amendment." (The Heritage Foundation)

Benefits in General; Executive Compensation

Plain Language Over Equity: The Supreme Court's Ruling in U.S. Airways, Inc. V. McCutchen
"As the Supreme Court strongly suggested when it simultaneously granted certiorari, vacated and remanded the Ninth Circuit's decision in Rose after publishing its decision in McCutchen, even terms as seemingly onerous as those at issue in Rose, expressly deviating from several common law rules, should be upheld by a court. It is only when a plan is silent or ambiguous as to a particular issue that background equitable principles can be used to fill the gaps." (Trucker Huss)

Press Releases

34th Annual Telly Awards Honor ASPPA’s “Save My 401k” Campaign
American Society of Pension Professionals & Actuaries (ASPPA)

BenefitsLink.com, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
Phone (407) 644-4146
Fax (407) 644-2151

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

Copyright © 2013 BenefitsLink.com, Inc. but feel free to forward this newsletter if done without modification in any way.

All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

Links to Web sites other than those owned by BenefitsLink.com, Inc. are offered as a service to readers. The editorial staff of BenefitsLink.com, Inc. was not involved in their production and is not responsible for their content.

Useful links: